函数法分析AFP和β-hCG在睾丸肿瘤中的变化

Changes of AFP and β-hCG in testicular tumors analyzed by a function method

目的:建立一种函数法分析AFP和β-hCG在睾丸肿瘤中变化的方法。方法:首先在睾丸根治术后复查AFP和β-hCG并计算其实测值坐标:以癌标实测值的半衰期个数为横坐标,癌标实测值的对数值为纵坐标。其次计算预测值坐标:设术前癌标实测值为a,半衰期个数为x,经过x个半衰期后预测值的对数值为y(以2为底取对数):y=log22axx+y=log2a(公式1),根据公式推导预测值坐标。最后比较癌标实测值与预测值坐标,了解是否有睾丸肿瘤残留或转移。结果:病例1为卵黄囊瘤和合体滋养层细胞的混合性生殖细胞瘤。其AFP和β-hCG在术后第10天的实测值坐标分别为(2.22,6.21)和(10,8.38),预测值坐标分别为(2.22,6.34)和(10,4.41)。该结果提示卵黄囊瘤尚未出现转移,合体滋养层细胞已出现转移。病例2为恶性畸胎瘤和卵黄囊瘤的混合性生殖细胞瘤,其AFP和β-hCG在术后第12天的实测值坐标分别为(2.67,-1.03)和(12,-3.32),预测值坐标分别为(2.67,1.41)和(12,-5.80)。但复查AFP和β-hCG的时间分别为2.67和12个半衰期,超过半衰期有效区间,此时癌标实测值均小于其正常值,可认为肿瘤无残留或转移。病例3为胚胎癌,其AFP在术后第1天的实测值坐标为(0.22,9.25),预测值坐标为(0.22,9.55),该结果提示胚胎癌尚未出现转移。结论:该方法预测的3例患者癌标变化均与实际病程吻合,睾丸根治术后如癌标实测值坐标与预测值坐标吻合,提示肿瘤尚未转移;如不吻合,则提示睾丸肿瘤残留或转移可能。

[Abstract] Objective： To establish a new function method for the analysis of ct-fetoprotein （AFP） and β-hCG in testicular tumors. Methods ： We reexamined the serum levels of AFP and β-hCG after radical orchiectomy, and calculated the measured coordi- nate, with the abscissa representing the number of the half-lives of tumor markers, and the ordinate representing the measured value of tumor markers. Referring to the measured value of tumor markers before surgery as a, the number of half-lives as x, and their theoreti- cal value over a period of x elimination half-lives as y （ logarithm to the base 2 of y） , we calculated the predicted coordinate according a to the formula y = log2^2x=x ＋ y = log2 ^＆（function 1 ）. Then we assessed tumor residue and metastasis by analyzing the relationship be- tween the measured and predicted coordinates. Results ： The pathological examination of case 1 revealed a germ cell tumor of a mixed histological pattern of syncytiotrophoblast and yolk sac tumor. The measured coordinates of AFP and β-hCG were （2.22, 6.21 ） and （10, 8.38）, and the predicted coordinates （2.22, 6.34） and （10, 4.41 ）, indicating the elimination of the yolk sac tumor and me-tastasis of the syncytiotrophoblast tumor. Case 2 demonstrated the mixed pathological nature of teratocarcinoma and yolk sac tumor. The measured coordinates of AFP and 13-hCG were （2.67, - 1.03） and （ 12, -3.32）, and the predicted coordinates （2.67, 1.41） and （12, -5.80）. But the review times of AFP and β-hCG were out of the effective range of half-lives, with the measured values below the normal, which suggested no tumor residue or metastasis. Case 3 was found to be embryonal carcinoma. The measured coordinate of AFP was （0.22, 9.25）, and the predicted coordinate （0.22, 9.55）, indicating the elimination of tumor. Conclusion ： The change of the tumor markers predicted by the function method coincided with the natural course of disease in the three cases. The coincidence of the measured with the predicted coordinate after radical orchiectomy indicates no metastasis, while their disagreement suggests possi- ble residue and metastasis of the tumor.